Predictors of cardiac events in high‐risk patients undergoing emergency surgery

Abstract

Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery. Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included.Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI 40.06 mg/l and NT-proBNP 41800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded. Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, Po0.001) and 30-day mortality (23% vs. 7%, P 5 0.003). Increased concentrations of NT-proBNP were

A meta-analysis of intraoperative factors associated with postoperative cardiac complications

“…1,6,7,9,[12][13][14][15][16][17][18] The characteristics of the included studies are shown in Table I. From the 11 included studies, five were prospective.…”

“…From the 11 included studies, five were prospective. 1,12,13,15,17 These studies recruited patients from a variety of surgical disciplines, and included both elective and emergency patients.…”

“…1 Only one of these studies controlled for hypotension and tachycardia, neither of which were independently predictive of adverse cardiac events in the presence of red blood cell transfusion and surgery exceeding 3.8 hours in duration (OR 2.2, 95% CI 1.3-3.7). 7 Other identified independent intraoperative factors included > 20 mmHg fall in mean arterial blood pressure for > 60 minutes (OR 3.0, 95% CI 1.8-4.9), 12 > 30% increase in baseline systolic pressure (OR 8.0, 95% CI 1.3-50), 17 tachycardia in the recovery room (> 30 beats per minute from baseline for > 5 minutes) (OR 7, 95% 1.9-26), 17 new onset atrial fibrillation (OR 6.6, 95% CI 2.5-20), 18 hypothermia (OR 2.2, 95% CI 1.1-5), 13 and remote ischaemic preconditioning (OR 0.22, 95% CI 0.07-0.67). 15 None of these studies controlled for blood transfusion.…”

“…Based on the five RCRI factors, 5 10 studies (91%) controlled for a history of ischaemic heart disease, 1,7,9,12-18 eight studies (73%) controlled for congestive heart failure, 1,6,7,12,14,[16][17][18] seven (64%) for renal dysfunction, 1,6,7,9,[16][17][18] seven (64%) for diabetes, 6,7,9,12,13,16,18 and three (27%) for stroke. 6,7,18 One study controlled for the number of RCRI risk factors.…”

“…6,7,18 One study controlled for the number of RCRI risk factors. 17 Two studies controlled for all five of the RCRI variables included in the European guidelines for cardiovascular assessment for noncardiac surgery, 7,18 two studies for four risk factors, 6,16 three studies for three of the risk factors, 1,9,12 two studies for two of the risk factors, 13,14 and one study for ischaemic heart disease only. 15 Primary adverse cardiac outcome…”